JEFFERSON MEDICAL COLLEGE • THOMAS JEFFERSON UNIVERSIT Y • SUMMER 2012
Marianne Ritchie, MD ’80 New Alumni Association President
An Aging America
Nation Braces for Geriatric Care Crisis
SEPTEMBER 21 – 23 Calling All JMC Graduation Years ’2s & ’7s!
HIGHLIGHTS THIS YEAR INCLUDE: • Friday - CME program. -A ll-alumni reception at the Mask and Wig Club — site of JMC dissecting rooms in the 1800s and listed on the National Register of Historic Places.
• Saturday - Special guest speaker Jonathan Eig, New York Times best-selling author of Luckiest Man: The Life and Death of Lou Gehrig. - Taste of Philadelphia luncheon hosted by Dean Mark L. Tykocinski, MD. - Morning and afternoon tours of the Rector Clinical Skills Center and the anatomy lab. - Reunion class receptions and dinners at the Union League of Philadelphia.
• Sunday - Pearls at Work: Fashion show and brunch for JMC alumnae and female faculty.
DISCOUNTED HOTEL RATES AT TWO AREA LOCATIONS: •U nion League 215-587-5570 • The Ritz Carlton 1-800-241-3333
For information, please call 215-955-9100 or email firstname.lastname@example.org
Visit our website
SUMMER 2012 1
6 Tarnish on the Golden Years: Geriatrician Shortage Persists 10 Closing the Gates of Hell: Stepping up Training for Treatment of PTSD 14 Review Sites Turn Patients into Critics
DEPARTMENTS 2 DEAN’S COLUMN 4 FINDINGS Drugs Targeting Chromosomal Instability May Fight Breast Cancer Subtype
16 FACULTY PROFILE
Elisabeth Edelstein, MD ’03: Teaching off the Grid
18 ON CAMPUS 23 Marianne Ritchie, MD ’80, Becomes JMC Alumni Association President 26 ALUMNUS PROFILE
Michael Ciminiello, MD ’02: Slugger to Surgeon
28 CLASS NOTES 30 IN MEMORIAM 33 BY THE NUMBERS
Jefferson Alumni Bulletin Summer 2012 Volume 61, Number 3 Senior Vice President, Jefferson Foundation: Frederick Ruccius Vice President for Development and COO, Jefferson Foundation: Stephen T. Smith Editor: Gail Luciani Associate Editor: Karen L. Brooks Design: JeffGraphics Bulletin Committee William V. Harrer, MD ’62 Chair James Harrop, MD ’95 Cynthia Hill, MD ’87 Larry Kim, MD ’91 Phillip J. Marone, MD ’57, MS ’07 Joseph Sokolowski, MD ’62 THOMAS JEFFERSON UNIVERSITY
On the cover: Marianne Ritchie, MD ’80, new JMC Alumni Association President. Photo by Ed Cunicelli.
Quarterly magazine published continuously since 1922 Address correspondence to: Editor, Alumni Bulletin Jefferson Medical College of Thomas Jefferson University 925 Chestnut Street, Suite 110 Philadelphia, PA 19107-4216 215-955-7920 Fax: 215-503-5084 connect.jefferson.edu Alumni Relations: 215-955-7751 The Jefferson community and supporters are welcome to receive the Alumni Bulletin on a regular basis; please contact the address above. Postmaster: send address changes to the address above. ISSN-0021-5821 Copyright© Thomas Jefferson University. All Rights Reserved. JG 13-0005
2 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
The Dean’s Column On May 21, 2012, Dean Mark Tykocinski, MD, shared the following comments with JMC graduates at Jefferson’s 188th commencement ceremony. His remarks appear here, adapted, in lieu of his usual column. Today, you carry with you your hopes and dreams, as well as those of the families who support you, and the faculty who have vested so much in you. Your futures hold opportunities to provide compassionate care, discover cures and educate the next generation of caregivers. You have been trained to be Jefferson’s ambassadors to the world. As such, my parting message to you speaks to your sense of empowerment. I draw lessons from a Nobel laureate, a moon-mission astronaut and a world-class pianist. First, dream big. Supplement the dayto-day with ambitious goals, and do not underestimate your own catalytic power. Recognize your inner agency — one that transcends self-imposed limits and empowers you to influence events even on the largest of stages. The story of my own mentor, Dr. Bernard Lown, is illustrative, and speaks in particular to how a single physician’s agency can play out in a remarkably short time frame. Back in the 70s, I was a clueless Yale undergrad hunting for a summer job in Boston, wandering the hallways of Harvard’s School of Public Health, literally just looking for an open door. I stumbled into Lown’s office. What followed was a life-changing, Forrest Gump-like cascade — three intense summers with one of the world’s most remarkable physician-
scientists and a close-up view of how a single physician with a clear goal can move mountains. Many believe Lown should already have received the Nobel Prize for Medicine — after all, he discovered cardioversion with pulsed DC current, the ‘Lown waveform,’ and pioneered the cardiac defibrillator. Yet, while the medicine prize has eluded him thus far, what has come his way is the Nobel Peace Prize. This he shared in 1985 with a Russian cardiologist, in recognition of their co-founding the International Physicians for the Prevention of Nuclear War — a forceful non-political pressure group, upwards of 150,000 physicians worldwide, that has alerted the public to the sheer insanity of nuclear proliferation. What stands out in Dr. Lown’s remarkable saga is just how quickly it all unfolded. It was a mere four years from the first IPPNW congress, to Lown’s standing on the podium in Stockholm with Nobel medal bestowed. A mere kernel of a thought in one physician’s mind — why cure individual patients if we are all but a key stroke away from mass annihilation? Any of us could have had this thought. Any of us could have acted on it. But we didn’t. Lown did. Lown acted on this thought. And a mere few years later, he flew from his secluded perch in academia to a world podium — catalyzing a world-class movement of physicians, penetrating the Iron Curtain and deploying citizen diplomacy to influence a superpower dialogue. And what makes this so tangible is realizing how close I was to these unfolding events — just 30 feet down the hall from Lown’s office, as the
embryonic seeds for his Nobel journey were being sown. So do not limit yourselves — dream big, take the first small steps, persist in a singleminded way, and know that big things can sometimes be achieved in remarkably short time frames seemingly in the blink of an eye. You too can shape, and even shake the world, and, if you are time-efficient, you can even do this on the side, while holding a day job! ‘Be realistic’ is a message you’ve had pounded into you like a drumbeat over the years. But I’m now urging you to titrate in a bit of unrealism — open yourselves up to greater possibilities — certainly have realism ground you, but don’t let it cage you. Parallel tracks can unfold far more quickly than you might otherwise dream possible. Second, sometimes you can shake the status quo in lightning speed, like Lown, and be there to garner the glory, but at most times, you are simply laying cornerstones and foundational bricks, for edifices that others will cap off. Often, we are initiators, enablers — fated to concede the limelight to others who finalize what we introduce. Understand that this enabling role, in projects and initiatives that reach beyond us in time and place, is no less noble and remains the most worthy of ambitions. The metaphor of ‘the third astronaut’ capsulizes this thought. Some of my contemporaries in the audience may remember a song by the rock group Jethro Tull, titled “For Michael Collins, Jeffrey and Me.” Released in 1970, one year after the first moonwalk, this song was a tribute to Michael Collins, the Apollo 11 astronaut who stayed behind as command module
SUMMER 2012 3
pilot, orbiting the moon and minding the mother ship Columbia, as his two fellow astronauts, Neil Armstrong and Buzz Aldrin, descended in the L.E.M., the lunar module Eagle, and stepped into the limelight of history — the image of their feet touching the moon’s surface beamed to billions back on planet Earth and imprinted forever on mankind’s collective psyche. All eyes were on Armstrong and Aldrin; few, if any, thought about Collins — the third forgotten astronaut — who piloted Columbia almost a half-million miles round-trip, came close enough to almost touch the moon, but never set foot on it. What a powerful metaphor for the enabler, for selflessness, for teamwork. When interviewed later, Collins claimed that what preoccupied him the most was his concern that Aldrich and Armstrong would not make it back to the mother ship, leaving him in the unenviable position of returning to Earth alone. But the lyrics to the Jethro Tull song intimated a more complex psychology at work, projecting an ambivalent Collins: I’m with you L.E.M. though it’s a shame that it had to be you. The mother ship is just a blip from your trip made for two. I’m with you boys, so please employ just a little extra care. It’s on my mind I’m left behind when I should have been there. Walking with you. “I’m left behind when I should have been there” — a bittersweet lament, conveying the mixed emotions of a man forced to watch his two partners moonwalk into history. And yet, Collins played his role, dutifully. This third astronaut metaphor has many resonances, even harkening back to biblical Moses — who after 40 years of trials and tribulations wandering the desert, was denied the privilege of accompanying his people over the Jordan River and into the Promised Land. So sometimes as agents, we are privileged to be like Lown — driving accomplishments that unfold quickly; recognized and rewarded as prime movers. But at other times, we are enablers like Collins — not privileged to carry the baton on the final leg
of the race, but rather destined to yield the finish line snapshot to others. To probe the path of the enabler just a bit more — a former colleague once shared with me a profound Greek saying: “Do the good deed and throw it in the sea.” What is the implication? That one should never expect recognition or compensation for one’s good deeds. A wise saying, but is it entirely true? Is doing the good deed a matter of selfless giving, with no personal return? I would opine ‘no’. There are personal returns even for the enabler. Acts of enablement yield returns to the giver. In enabling, you are growing yourself. Acts of selflessness provide a framework for, and
“Embrace challenges undaunted, and eagerly seek out problems to be solved. No obstacle is too daunting!” become part-and-parcel of, your own selfdevelopment — Nietzschean self-creation if you will. A final message to you is about persistence and fearlessness in the face of challenges. Embrace challenges undaunted, and eagerly seek out problems to be solved. No obstacle is too daunting! As you manifest your agency, whether or not recognition will be your fate, do so with relish for the difficult — just take the first steps, because time and again, your sheer agency and initiative will somehow make the obstacles before you melt away. Paradoxically, the challenges are often the most empowering, pointing to imaginative solutions and driving innovation. We all have our own favorite inspirational anecdotes — of someone who has tackled seemingly insurmountable obstacles, triumphing through persistence. On my personal list is the pianist Leon Fleisher, one of the true giants of the 20th century keyboard. Fleisher made his public debut at age 8, and by age 16, played with the New York Philharmonic, who labeled him “the pianistic find of the century.” Fleisher
became one of the few child prodigies to be accepted for study with Artur Schnabel, linking him to a tradition that descended directly from Beethoven himself. And then, like the hero of a Greek tragedy, at 36 years of age, he suddenly and mysteriously became unable to use two fingers of his right hand. Fleisher recalls the depression that engulfed him as his condition worsened, but even more powerfully the sheer love of music that rescued him from complete self-destruction. That love of music manifested itself in his starting to conduct, but far more compelling, in his continuing to play — now with his left hand only. Fleisher started to perform left-handed repertoire, all the while searching for a cure for his condition. Miraculously, at 66, his condition was diagnosed as focal dystonia, and cured by experimental Botox injections. Having regained the use of his right hand, he returned to Carnegie Hall in 2003 to give his first two-handed recital in over three decades, bringing down the house. But it is not so much Fleisher’s return with two hands that makes him a legend, as it is the 50 years he pressed forward with his weaker left hand, developing new strengths as he faced new obstacles. He inspired the American composer William Bolcom to compose “Concerto for Two Pianos, Left Hand.” And Fleisher rescued Paul Hindemith’s “Klaviermusik Piano Concerto for the Left Hand,” written years earlier for the Austrian pianist Paul Wittgenstein, who lost his right arm in World War I. Fleisher premiered the work in 2004 with the Berlin Philharmonic. Fleisher’s left-handed piano saga didn’t end there. At age 82, he underwent surgery on his right hand, requiring him to rest it for a number of weeks. This did not deter him from proceeding with a scheduled concert at Muhlenberg College, once again performing left-handed works only, and concluding with Brahms’ arrangement for the left hand of the Chaconne from Bach’s “Violin Partita No. 2 in D Minor”. So, Class of 2012, you are more empowered than you think — whether you see the fruits of your labors in a short continued on page 31
4 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Findings Drugs Targeting Chromosomal Instability May Fight Breast Cancer Subtype Researchers at the Kimmel Cancer Center at Jefferson have peeled back another layer of breast cancer genetics. Led by Richard G. Pestell, MD, PhD, director of the KCC and chair of the Department of Cancer Biology, the researchers have shown that the oncogene cyclin D1 may promote a genetic breakdown known as chromosomal instability (CIN) — a known yet poorly understood culprit in tumor progression. Their study used various in vitro and in vivo model systems to show that elevated levels of cyclin D1 promote CIN and correlate with CIN in the luminal B breast cancer subtype. Cyclin D1 protein is elevated in breast, prostate, lung and gastrointestinal malignancies. The findings suggest that shifting towards drugs targeting CIN may improve outcomes for patients diagnosed with luminal B subtype. Luminal B breast cancer has high proliferation rates and is considered a high-grade malignancy. Luminal B subtypes are characteristically hormone receptor positive (estrogen/
progesterone) and often Her2 positive, about 20 percent of patients are diagnosed with it every year, though many do not respond well to treatment. The identification of CIN in luminal B provides a new therapeutic opportunity for these patients. “Cyclin D1 has a well-defined role in cell proliferation through promoting DNA replication,” Pestell says. “My team was the first to discover that cyclin D1 also has alternate functions, which include regulating gene transcription at the level of DNA. We were interested in discovering the function of DNA associated cyclin D1.” To help answer this, the researchers, including lead author Mathew C. Casimiro, PhD, of the Department of Cancer Biology, first needed to directly access cyclin D1’s role in gene regulation. They applied an analysis known as ChIP sequencing to study the protein’s interactions with genes that comprise the entire mouse genome, and found it occupied the regulatory region of genes governing chromosomal stability with high incidence.
Chromosomes in a normal breast epithelial cell.
They went on to show cyclin D1 promoted aneuploidy and chromosomal rearrangements typically found in cancers. Faulty chromosomes — either too many or too few, or even ones that are the wrong shape or size — have been shown to be the crux of many cancers. However, a major question of cancer genetics is the mechanisms of CIN. What causes the breakdown in chromosomal stability? As cyclin D1 expression is increased in the early phases of tumorigenesis, cyclin D1 may be an important inducer of CIN in tumors. To analyze the association between CIN and cyclin D1 expression in the context of breast cancer, the team aligned an expression of a 70-gene set with the highest CIN score against over 2,000 breast cancer samples. They stratified the samples based on previously described subtypes and aligned them with cyclin D1 expression profiled across the dataset. A significant correlation among CIN, cyclin D1 and the luminal B subtype was identified, and it was apparent that the relationship between these levels was subtype specific.
SUMMER 2012 5
“Interestingly, previous studies have presented contradictory results,” Pestell says. “Many studies have suggested a positive correlation between cyclin D1 expression and outcomes, while others have shown reduced survival. Here, we’ve dug deep, using a genome-wide analysis, and found that overexpression of the protein appears to be directly associated with the genes involved in CIN and this correlates with the luminal B subtype.” Drugs targeting chromosomal instability for cancer therapy have been explored, but a sub-stratification rationale for the luminal B subtype has not been established. The research presented in this study suggests such a target is worthy of further investigation. “There is a big drive toward using targeted therapies for stratified breast cancers,” Casimiro says. “What we are thinking is that there are a growing number of drugs that target aneuploidy, like AICAR and 17-AAG, in conjunction with cyclin D1 inhibitors, which may be used as an adjuvant therapy in patients with luminal B breast cancer.”
Cells treated with drugs that exploit CIN (AICAR or 17-AAG) may selectively target and destroy luminal B breast cancer cells. In untreated cells, cyclin D1 contributes to CIN, leading to tumor progression.
Elevated levels of the cyclin D1 protein are found in the early phase of tumorigenesis, causing an increase in aneuploidy.
6 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Tarnish on the Golden Years: Geriatrician Shortage Persists By Karen L. Brooks
SUMMER 2012 7
STORY SUMMARY More than 75 million aging baby boomers are shedding light on a nationwide shortage of geriatricians. Not enough physicians are trained in managing the multiple chronic conditions and other healthcare issues faced by older patients. Students and residents turn away from geriatrics because of salary concerns, poor reimbursement rates and a general lack of prestige attributed to the specialty. Experts recommend increased exposure to geriatrics during training as well as financial incentives to draw students and residents toward geriatric medicine.
Certain that she was too old to bother with aggressive treatment, an 85-year-old stomach cancer patient recently frustrated her physicians by refusing the surgery they knew could save her life. But a consultation at Jefferson’s Senior Adult Oncology Center changed her mind. During a two-hour appointment, she met with a multidisciplinary team including a geriatrician, an oncologist, a pharmacist, a social worker and a dietician, all of whom work exclusively with older patients. They showed her that she was healthier than she thought, and she ultimately agreed to go through with the operation. She left the hospital within a week and today is thriving at home. “Age alone is not a reason for someone to reject care, but it happens all the time,” says Andrew E. Chapman, DO, a geriatric oncologist and co-director of the Senior Adult Oncology Center. “The most rewarding part of our work is the impact we have on a patient’s decisions. We help older patients and their families understand that treatment often is manageable and worthwhile — that aging does not mean you have to give up.” Unfortunately, this level of comprehensive guidance and care proves rare for many older Americans. A nationwide shortage of geriatric specialists is worsening as the first of more than 75 million baby boomers reach their senior years. According to the Association of American Medical Colleges, geriatrics ranks 34 out of 36 specialties based on the number of physicians practicing in the United States, with fewer than 8,000 certified geriatricians currently working — a woefully inadequate figure, experts say, considering that 10,000 people are turning 65 every day. Photos by Sabina Pierce.
“Older patients bring complexity to the table. Any illness they experience is likely compounded by conditions like diabetes, arthritis, osteoporosis, hypertension, decreased kidney function or dementia.” – Susan M. Parks, MD
“Older adults are the fastest-growing segment of our population, and it’s common for them to face multiple chronic conditions, more than a dozen medications and varying degrees of forgetfulness,” says Jennie Chin Hansen, RN, chief executive officer of the American Geriatrics Society, an organization of health leaders focused on geriatric patient care, research, education and policy. “These patients can’t just jump from specialist to specialist. What they need is a general contractor for their bodies — not a plumber or an electrician, but someone who understands the whole building.”
Boomers Demand Greater Work Force
The size of the baby boomer group combined with a general increase in life expectancy means that by 2030, one in five Americans will be over 65 — a larger percentage than ever before. In a landmark report, Retooling for an Aging America: Building the Health Care Workforce (2008), the Institute of Medicine, or IOM, estimated that fewer than one-quarter of the 36,000 geriatricians needed to accommodate older patients will be practicing at that time. The IOM reports that just 20 percent of Americans older than 65 see a geriatrician, with the rest using a standard primary care physician. But healthcare professionals say failure to build a relationship with a geriatrician can lead to compromised care over time. Ninety percent of adults in that bracket have at least one chronic health condition, and older individuals present unique caregiving challenges. “Older patients bring complexity to the table. Any illness they experience is likely compounded by conditions like diabetes,
arthritis, osteoporosis, hypertension, decreased kidney function or dementia,” says Susan M. Parks, MD, director of Jefferson’s Division of Geriatric Medicine and Palliative Care. “Geriatricians have expertise in managing all these issues at once, while general internists usually don’t.” Parks explains the dangers of treating older patients the same way as younger ones: “We have to consider the risks of overmedicating or mixing drugs in older bodies, which cannot tolerate the same dosages as younger bodies. And we must analyze every patient’s support system. Who is getting them to and from appointments? Who is picking up their medication? Our patients can’t always do these things for themselves, and we need to find out who is there to help.”
Interest Trending Downward
Despite a growing need for geriatricians, medical trainees are veering away from the specialty. The American Geriatrics Society reports that last academic year, just 56 percent of first-year geriatric fellowship slots were filled; from 2005 to 2009, the number of internal or family medicine residents who began geriatric medicine fellowship programs decreased from 112 to 86. “I’ve had an average of 10 residents a year since 1989, which means I’ve taught more than 200 residents,” says Bruce G. Silver, MD ’74, chief of geriatric medicine at Main Line Health, just outside Philadelphia. “And you know how many of them have gone on into careers in geriatrics? Two.” Many factors contribute to the specialty’s lack of appeal, with financial concerns topping the list. Geriatricians rank among the lowest-paid physicians, with a median salary of about $183,000 in 2010. That’s
8 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
“The boomers are forcing the issue: This is the future of medical care, and everyone better be poised to deal with it.” – Andrew E. Chapman, DO less than half the median of specialties like orthopaedics and radiology, a discrepancy that can discourage students who now leave medical school an average of $160,000 in debt. And although they are paid less than their colleagues in general primary care, geriatricians train at least one year longer. “Geriatrics is the only fellowship that an internist can complete and end up making less money than she would if she went directly into practice and did no fellowship at all,” says Christine A. Arenson, MD ’90, vice chair for academic affairs in the Department of Family and Community Medicine, associate professor in the Division of Geriatric Medicine and
Some geriatricians believe that because their field isn’t rooted in lucrative, cuttingedge procedures or technology, people see their work as boring or even inferior. “If you drive around your city, you’ll probably see hospital billboards advertising the latest medical robots or other gadgets. But geriatrics isn’t sexy or prestigious enough for a billboard,” Silver says. Limited exposure during training can impart that bias onto students. A 2008 study out of the University of Cincinnati showed that only about half of U.S. medical students had clinical rotations in geriatrics. And geriatric medicine is not a recognized specialty through the
national match program creates a major visibility issue,” she says. “It’s unfortunate, because older patients value a doctor who is focused on their specific stage of life. Their needs are complex in that our relationship doesn’t just involve a disease process — it involves where they’ve been and where they’re going.” Regardless of the concerns causing young physicians to bypass the field, geriatricians emphasize the urgency surrounding their work. “Students need to realize that a deluge of older patients is coming, and they must be trained to handle what’s coming down the pipeline. You don’t think of children as small adults — you take them to a pediatrician. And you can’t think of seniors as just old adults. They need special attention, too,” Chapman says. “The boomers are forcing the issue: This is the future of medical care, and everyone better be poised to deal with it.”
Christine Arenson, MD `90, meets with patient Eva Cirucci at the Philadelphia Senior Center.
Palliative Care and co-director of Jefferson’s Senior Adult Oncology Center. Medicare reimbursement, the top source of income for most geriatricians, amplifies apprehension. The government’s fee-for-service system, which most private insurance companies imitate, overlooks many of the services geriatricians provide. “Ours is a job of talking more than performing procedures, and our system tends to reward procedures over care coordination. Just assessing an older patient’s medications can take 20 minutes, and that’s time you aren’t compensated for. Our appointments are based on counseling patients and their families in an effort to manage conditions, not to cure them with some sort of billable procedure,” Arenson says.
National Resident Matching Program; students usually pursue internal medicine residencies before transitioning into a geriatrics fellowship. “Geriatrics isn’t presented as an attractive specialty during school,” says Patricia M. Curtin, MD ’88, chief of geriatric medicine for Christiana Care Health System in Delaware. “Most family or internal medicine residents come in without ever having considered geriatrics, and then we have to switch their gears at that late stage.” Jenny S. Chiang, MD, is one trainee whose gears have been switched. A geriatrics fellow at Jefferson, she believes many students don’t even realize they can cultivate a career exclusively in geriatrics. “Geriatric medicine’s omission from the
What can be done to draw more attention toward geriatrics? Several things, according to the experts. Obvious solutions include implementing loan forgiveness programs for students who pursue the specialty and amending reimbursement rates for the services geriatricians provide. The American Academy of Family Physicians suggests a “per-beneficiary, per-month stipend for care management, paid directly to the patients’ designated personal physician.” Many groups have pushed for new reimbursement guidelines for time spent coordinating care across various settings — such as in nursing homes — and communicating with patients’ families. And new federal regulations include provisions supporting geriatrics education. Last year, $30 million in federal grants funded geriatrics training programs. Jefferson receives funding from the Health Resources and Services Administration — part of the Department of Health and Human Services — to train JMC students as well as nursing, pharmacy and health professions students.
SUMMER 2012 9
Andrew E. Chapman, DO, examines patient George Logo.
“Interprofessional training is key, because doctors aren’t the only ones caring for older patients. We have standard geriatrics instruction but then there are things like Jefferson’s Health Mentors Program, which provides great longitudinal experience,” says Arenson, referring to a program in which Jefferson students are matched with volunteer “mentors” who have chronic health conditions — usually older adults. Students interact with their mentors for two years, learning firsthand what really matters to the patient. Curtin agrees that cross-training is essential. “We need to tap all resources in order to fill gaps in care. Everyone in the healthcare system — nurses, therapists, social
workers — should have some background in treating older patients and recognizing the challenges they present,” she says. To provide that background, geriatricians recommend mandatory geriatrics rotations for students and residents plus connections with nontraditional medical sites like nursing homes (Jefferson has an outpatient clinical and teaching program in the Philadelphia Senior Center, which serves local residents 55 and older). “Students are not exposed to geriatric patients in a variety of settings,” Parks says. “They see many hospitalized patients but don’t get to see ambulatory older people. They need to interact with older adults in healthy stages so they see them as normal people, not frail people. People with complex
conditions can live extremely well, and students don’t see that enough.” But above all, Bruce Silver believes students need more enthusiastic instructors. “We are taught that geriatric patients are difficult and time consuming, and then they die,” he says. “But if you take on a rotation, I guarantee you will enjoy it. Students should have the opportunity to see the rewards that come with our work.” And Silver is not talking about financial rewards. He recently received a letter of thanks from the daughter of a longtime patient who passed away — a letter that deeply moved him. “You can pay me an extra $100,000, and I’ll spend it,” he says. “But if you mail me a letter like that, I’ll hold onto it for life.”
10 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Stepping up Training for Treatment of PTSD
Scott Nelson/Stringer/Getty Images
SUMMER 2012 11
“Anybody that’s been to the gates of Hell has PTS.” — Capt. (ret.) Paul Bucha, Medal of Honor Recipient, June 2010 By Gail Luciani
We see it in the news with frightening frequency. A family massacred in Afghanistan. A National Park Ranger murdered in Washington. The uptick in suicide among soldiers. War takes a toll, and those closest to it often continue to live with the pain in the form of post-traumatic stress disorder, or PTSD. In July 2010, the Honorable Eric Shinseki, Secretary of Veteran Affairs, said, “Psychological wounds can be as debilitating as any physical battlefield trauma.” According to the VA, 197,133 Iraq and Afghanistan veterans were diagnosed with PTSD by mid-2011. Defined by the American Psychological Association as an anxiety problem that develops in some people after extremely traumatic events, such as combat, crime, an accident or natural disaster, PTSD is often perceived as the cause of behavioral problems ranging from acts of atrocities to road rage. Victims
STORY SUMMARY More than 100 medical schools, including Jefferson, have committed to stepping up training for medical students in how to treat PTSD and traumatic brain injury in response to a new initiative from the White House. Since 9/11, the American public has become increasingly aware that PTSD can affect civilians as well as military personnel. Chronic untreated trauma can have a corrosive effect on the mind, body and soul. It’s important that physicians know how to look for trauma no matter what their specialty is.
may have intense memories and relive the traumatic event with flashbacks and nightmares. And they may avoid anything that reminds them of the trauma because of the intensity of their feelings. Soldiers with PTSD lack obvious physical trauma from the battles they survive; their wounds are invisible but no less real. Previously called “shell shock” or “battle fatigue syndrome,” PTSD was formally recognized in 1980 when it was added to the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III). “Mental health issues are still a stigma in the military, where full confidentiality is not offered,” says Krystal Stober, PsyD, clinical psychologist and faculty member at Jefferson. “So patients may find us through their primary care provider or because they are suffering from chronic health issues and their physicians refer us. That’s why it’s important to integrate behavioral health with primary care.” The Army increased its behavioral health care services by more than 10 percent in 2011; this demonstrates a change in attitude, as military leaders are now recognizing the importance of caring for both the mental and physical health of its troops. Soldiers who are trained killers can have trouble letting go of that role after returning home. Even driving can be an ordeal because their combat experiences were frequently defined by dangers on the road. A New Commitment from Medical Schools
To support this changing attitude in the military, in January 2012 the White House announced that more than 100 medical schools in the United States had committed to stepping up training for medical students in how to treat PTSD and traumatic brain
injury. The promised commitment includes increased research and the sharing of new knowledge and best practices. JMC is one of the schools committed to this initiative. “We’re doing a good job of both teaching students about trauma and treating it at Jefferson, but we need to improve coordination of trauma education between departments,” says Stober. “Trauma is already included in the coursework, but the White House initiative has helped us put the big picture into focus so that we can make sure we are filling gaps. For example, how to deal with trauma is taught in departments as diverse as surgery and pediatrics, but there isn’t a comprehensive teaching plan for trauma yet.” Combat Not Only Traumatic Stressor
Studies have highlighted the difficulties that troops can face when they return home, but trauma cuts a wide swath in behavioral health. “We need to remember that there is a broader application for PTSD — it’s not just war veterans,” says Marion Rudin Frank, EdD, a private practitioner who has been treating trauma patients for more than 30 years. “We are recognizing PTSD more now, where we may have made another diagnosis in the past. It’s more accepted today because psychology is more respected.” According to Ira Brenner, MD ’76, clinical professor of psychiatry at Jefferson, since the attacks on the World Trade Center and the Pentagon on Sept. 11, 2001, the American public has become increasingly aware that PTSD can affect civilians as well as military personnel. “Some of the most traumatized people I have seen are oblivious to the causeeffect relationship between their symptoms and what they have survived,” says Brenner. “The astute clinician has to be open-minded
12 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
and consider the diagnosis because the patient may not, surprisingly, make the connection himself.” Dalit Gross, PsyD, agrees. “Some people may only know that something is wrong — for example, they may be hyper-vigilant or anxious — so they see a physician for a different reason,” says Gross, a psychologist who is a member of a research team working on an NIMH-funded research study on PTSD at New York State Psychiatric Institute. “That’s why a comprehensive intake evaluation is important.” Undiagnosed trauma can distort how a person’s behavior is perceived, which could lead to problems with diagnosis. “It’s important to acknowledge the role of trauma because it helps put the person, his behaviors and his feelings into perspective. For example, if a patient’s response is incongruent to a situation, like jumping when you make physical contact, you might be unknowingly triggering a traumatized patient,” says Stober. “To get the best clinical picture of a patient, we want to first take time to understand behavior before making a diagnosis or writing a prescription.” Patients need their primary and other care providers to be sensitive to their needs. “Doctors see a lot of people, and they expect everyone to respond the same way. But I’m not like every patient,” says Mikayla, a patient being treated for trauma at Jefferson. “Even the smallest thing can trigger me; the way you touch me, something you say. I need my doctors to be aware of how they should handle me so that I can feel safe in their offices. People take things like safety for granted. But I can’t close my eyes at night and trust that I’ll be safe like everybody else. Trauma patients
Krystal Stober, PsyD, listens to a patient. Photo by Sabina Pierce.
don’t have that trust because their trust has been taken. I’ve had doctors actually get angry at me for that.” Treatments That Can Make a Difference
There are various forms of treatment for PTSD, from medication to talk therapy that will help a patient construct a cohesive narrative. Mindfulness programs, such as the one at Jefferson, can also help. “As a physician, what’s important is taking the time to really listen,” says Gross. “Take a moment to listen to the whole story
because you will hear important clues in the details.” Medication for PTSD continues to be evaluated, and earlier this year the VA issued guidelines that recommend against using benzodiazepines to treat symptoms. “If you have a patient who has been recently traumatized and you prescribe a benzodiazepine, research tells us that this person’s likelihood of developing PTSD increases significantly,” says Stober. “We’re not sure exactly why this is true, but it could be because when there is trauma, we need to normalize and process what happened.
SUMMER 2012 13
“It’s important that all physicians, no matter what their specialty, know how to identify and care for traumatized patients. In every field, we have to make sure that we provide trauma-sensitive care.” — Krystal Stober, PsyD
Benzodiazepines suppress our physiological and emotional responses, allowing us to in essence sweep the trauma under the carpet and delay processing what happened.” Addressing Comorbidity and Providing Support
PTSD is often accompanied by other psychiatric and health conditions, so researchers are investigating methods of combining treatment. One study integrates treatment to alleviate symptoms of both PTSD and chronic pain, combining aspects of cognitive processing therapy for trauma and cognitive behavioral therapy for chronic pain. Experts say that substance abuse, violent behavior and suicide should all be considered in treating PTSD. Substance abuse in the military is common, and suicide among soldiers is a growing problem. In 2011, 164 active-duty Army, National Guard and Reserve troops took their own lives, even as the Army expanded suicide prevention efforts and drug and alcohol counseling. Violent crimes by active duty troops have increased 30 percent during the same time period. Increased social support is important for patients with PTSD, and buddy or peer-topeer involvement has increased the number of veterans seeking treatment. Because families are affected as well, they should be included in determining the plan of care. “Returning to civilian life can be very challenging, which is why the availability of resources, including social support, is an essential part of that reintegration,” says Gross. The Wounded Warrior Project provides direct programs and services to meet the needs of injured service members. One organization it supports is K9s for
Warriors, which trains dogs to act as therapeutic tools for veterans coping with PTSD. These service canines provide support on an instinctual level and are a medically proven recovery aid for soldiers suffering from PTSD. Expressive writing has been studied as a possible tool to help service members get back their sense of self. Patients who put their thoughts and feelings into words showed improved mental health, better immune system functioning and fewer doctor visits. Another creative outlet is acting, which some patients use as a means of dealing with their personal traumas, because it allows them to create their own cohesive narrative. Jefferson’s Commitment
“At Jefferson, we don’t see many veterans for their mental health or substance abuse issues because there is a local VA Hospital, though we do have a residency rotation there for psychiatry residents. Some veterans, however, choose to get their care here because they find the VA triggering; it can be difficult to be surrounded by other wounded soldiers. We offer a safer, more neutral environment for those folks,” says Stober. In addition to the residency program, a trauma series in coursework for psychiatry residents saturates them with information about trauma. “There is a whole realm of symptoms, trauma-related disorders, before full-blown PTSD,” says Stober. “Our medical students rotate through psych and learn how to assess trauma as well as how to work with someone who has been traumatized. We teach residents to pay attention, to make sure looking at trauma is in their repertoire.” Coursework for students addresses the various levels impacted by trauma:
biological, psychological, spiritual, social and behavioral. “Chronic untreated trauma can have a corrosive effect on the mind, body and soul. It may be that a significant contribution to the morbidity associated with the so-called diseases of middle age can be attributed to the unrecognized psychophysiological complications of unresolved grief, depression, survivor guilt and post-traumatic anxiety,” says Brenner. An educational series for first-year students teaches motivational interviewing, or how to talk to a patient. “Inevitably I get the question, ‘How is this relevant to me if I am going into cardiology or neurology?’ I let them know that no matter what field they go into, they need to be able to work with people and understand what they are going through,” says Stober. What’s Important
“The White House initiative is making us think more holistically; however, we need to think beyond combat trauma. There are many traumatized people who are in dire need of help, not just veterans,” says Stober. “It’s important that all physicians, no matter what their specialty, know how to identify and care for traumatized patients. In every field, we have to make sure that we provide trauma-sensitive care.” According to Brenner, Jefferson will be much better prepared to address the needs of veterans as a result of the educational initiatives and programs that are being put into place. Students are being trained to help their patients with PTSD “close the gates to hell.” “If you are doing good therapy, that’s the main thing,” says Frank. “My advice to medical students? Listen.”
14 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Review Sites Turn Patients into Critics
Illustration by Adam Niklewicz
SUMMER 2012 15
By Karen L. Brooks
Restaurants. Beauty salons. Car dealers. Home improvement specialists. Today, consumers can browse online reviews for virtually any service before deciding which to use. And that includes medical practices. Every month, more than 100,000 patients across the United States rate their physicians online via websites like RateMDs, HealthGrades, Book of Doctors and Vitals, which provide an open forum for commentary on everything from waiting room décor to reception staff to bedside manner. These sites have caused headaches for many physicians, who have little power when it comes to rebutting false or negative reviews. Often, reviewers don’t have to attach a real name to their submissions, and site owners fail to verify that reviews are truthful. And while some sites do allow physicians to post public responses, many are afraid to do so because of patient privacy concerns. “There is no legal obligation for a site owner to ensure that reviews are credible,” says David G. Post, cyberspace law expert and professor at the Temple University Beasley School of Law in Philadelphia. “Even if defamation occurs, the site owner is immune from liability — he is seen as the distributor of the libelous information, not the publisher, who is a third party. A person who wants his site to be reputable should take complaints seriously, but if he doesn’t, there really aren’t any repercussions.” The Ratings Police
Although site owners can leave negative reviews alone, many do attempt to curb
Physicians can’t control everything that’s posted about them online, but they can protect their reputations in various ways. “medical astroturfing” — physicians paying marketers or their staff to blanket the Web with fabricated reviews. Most of the largest review sites use automated algorithms to catch obvious fakes. “We have no foolproof way of knowing that ratings are from real patients, but we can filter out spam reviews just like anyone can filter out spam emails,” says John Swapceinski, founder of RateMDs, a physician rating site that averages 2 million visitors per month. “When multiple reviews are posted by one person about the same practice, that’s a concern. We also keep tabs on a few companies known to accept money to plant reviews, and we look for ‘advertisement-speak’ — language that sounds like a professional ad. “Other fakes can be weeded out by the IP address used for posting, which can be tied to a doctor’s office. Are patients posting reviews right from their doctor’s computer? Doubtful.” Swapceinski says that a “real, live person” reads all RateMDs reviews to check for questionable content. And any user can click an icon next to a review to flag it as suspicious; employees will review and determine whether it violates policies. But even if phony reviews are pinpointed, proving who posted them is usually impossible, thanks to the anonymity of the Internet. In fact, only one medical corporation has ever officially been found guilty of astroturfing — a cosmetic surgery franchise called Lifestyle Lift. In 2009, the New York state attorney general’s office prosecuted the company for ordering employees to pose as patients and flood
ratings sites with accolades. Corporate emails, obtained after a subpoena, revealed the routine, and Lifestyle Lift received a $300,000 fine. Protecting Your Practice
Physicians can’t control everything that’s posted about them online, but they can protect their reputations in various ways. Some have begun requiring patients to sign contracts stating they will not post negative reviews; some ask patients to write favorable reviews following a good experience; and some use social networking platforms like Facebook, Twitter or personal blogs to create a positive online presence. And some physicians simply don’t pay reviews much attention. “Doctors don’t have time to spend fighting negative reviews, and that’s OK,” says orthopaedic surgeon Phillip J. Marone, MD ’57, MS ’07. “Patients deserve more credit than they get — they can figure out if a review is legitimate. They’re only going to avoid a practice if many negative reviews are posted, but if there are only one or two, I think they know to ignore them. These sites are often just a way for disgruntled people to complain about small issues that do not adequately capture a practice.” Swapceinski, on the other hand, believes reviews do hold significant power and advises physicians to ask their best patients to get writing. “People looking for local doctors tend to search online before making a decision,” he says. “Happy patients post positive reviews, and that’s good for any business.”
16 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Jefferson Faculty Elisabeth Edelstein, MD ’03: Teaching off the Grid
Dozens of tourists are trekking through Tennessee’s Great Smoky Mountains, a hiker’s paradise with its 900 miles of well-kept trails, when a storm blows in. Lightning strikes, and suddenly, chaos erupts. One person goes into cardiac arrest. Another has a ruptured ear drum. A third has experienced major head trauma. And the closest hospital is 50 miles away. What do you do? This is one of many scenarios introduced by Elisabeth Edelstein, MD ’03, during the wilderness medicine elective she leads every February. In conjunction with the Wilderness Medical Society, Edelstein takes third- and fourth-year medical students, residents and other healthcare professionals — from Jefferson as well as other institutions — on a month-long trip during which they learn extensive wilderness survival skills. Edelstein, assistant professor of emergency medicine at Jefferson, launched the elective in 2010. When she’s not guiding students through austere backcountry, she serves as assistant director of undergraduate emergency medical education and covers clinical shifts in the emergency departments at both Jefferson and Methodist hospitals. She also is a guest lecturer for Weill Cornell Medical College’s wilderness medicine course, traveling around the country to speak about environmental medicine. Edelstein drew inspiration for her wilderness medicine elective from a similar program she participated in as an emergency medicine
resident at New York Presbyterian Hospital. A lifelong lover of the outdoors, she realized she could marry her passion with her profession, and when she returned to Jefferson as a faculty member, she set out to show her colleagues the value of a wilderness medicine curriculum. She succeeded — and recently shared her views on her work. Q: Why is teaching wilderness medicine important? A: Living in a city doesn’t mean you’re always in the city. Physicians may be vacationing in remote areas when someone gets ill or injured, and many volunteer abroad or respond to disasters throughout their careers. Wilderness medicine has a significant overlap with global health — think of Hurricane Katrina or 9/11. We are teaching survival skills. It’s important that physicians know how to treat medical conditions even when they don’t have the technology they’re used to at their fingertips. We force students to focus on the physical exam, a skill that translates into any disaster zone. Q: What does the elective entail? A: We have three weeks of lectures, discussions, field training and scenario-based learning followed by a five-day Smoky Mountain hike. We’ve put together a scenario-based library with scripts for victims and patients, so there’s a lot of role-playing.
SUMMER 2012 17
Students take turns playing both physicians and patients, because understanding the patient experience is essential. For example, we act out a water rescue. When you’re in 50-degree water and pulled out into 40-degree air, you actually experience a bit of hypothermia. A student will never forget that feeling. The scenario-based learning makes for very memorable lessons.
Q: How do students react to this experience? A: The evaluation forms usually say something like, ‘This was the single best month of medical school.’ Our students appreciate the opportunity to learn what other schools’ curricula just touch on. We are giving them the tools they really need to manage these kinds of emergencies, whereas many schools quickly pass over these lessons. And we’re doing it while enabling them to take part in activities they enjoy, like backpacking and canoeing. Q: What are your favorite memories from past excursions? A: The best part about the elective is the wonderful group dynamic that develops. On our last trip, we walked through a cold creek, and all of our shoes and socks were wet. One woman was particularly struggling, and everyone else chipped in something from their own gear. One person made her tea, and someone else gave her food so she could get some calories in her to warm her up. People sacrificed their own warmth for hers. This sense of caring and responsibility is so meaningful. Q: What is your proudest professional achievement? A: I really have two. First, I am proud to have convinced Jefferson’s curriculum committee to accept this elective. Wilderness medicine is a relatively new field, and those of us who are enthusiastic about it are still working to legitimize it. I developed the syllabus and got a lot of tough questions when I presented it, but ultimately, the leadership here embraced my interests and supported my goals. And second, I am proud to have facilitated the Mid-Atlantic Student Wilderness Medicine Conference at Jefferson. In 2010, I supervised the students who led this conference, which drew 200 participants from schools as far south as Georgia and as far north as Canada. The success of that initial conference inspired a second group of students to coordinate another one, which we hosted at the end of March 2012 with equal success. Q: What do you like to do outside of work? A: I’m an avid runner and have completed six marathons. I’m also a huge fan of musical theatre and opera, going to the Philadelphia Orchestra or up to New York City to see shows as often as possible (as a student at Jefferson, I sang with the Arrhythmias, a women’s a capella group). And not all of my wilderness travel is work related; I still take trips for my own pleasure. My favorite vacation so far has been to the Swiss Alps. The beauty of the peaks and wildflowers — I can’t begin to describe it. — Karen L. Brooks
Top 10 Meds for Your Wilderness Medicine Kit Among Edelstein’s frequent lecture topics is a discussion on the most essential items for any physician’s wilderness medicine kit. Planning a backcountry trip? Here’s what she advises you to pack: • Ibuprofen such as Motrin® for headaches, menstrual cramps and hikers’ knee pain •A cetaminophen such as Tylenol® for fevers •H 1 and H2 blockers such as Benadryl® and ranitidine for allergies and sleep aid •A corticosteroid such as prednisone for allergic reactions and asthma • An epinephrine injection such as an EpiPen® for allergic reactions and asthma
•A ntibiotics such as doxycycline and fluoroquinalone for cellulitis and diarrhea •A local anesthetic such as lidocaine for pain management •A ntacids or other GI medicines such as TUMS® or Pepto-Bismol® for upset stomach •A nti-diarrheals such as Imodium® •D econgestants for nasal congestion
In addition to these medications, Edelstein also recommends that every traveler carry duct tape, “because you can improvise a lot of things, but tape isn’t one of them!”
18 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
People Pestell Named AAAS Fellow
Richard Pestell, MD, PhD, director of the Kimmel Cancer Center at Jefferson, was named a 2011 Fellow of the American Association for the Advancement of Science. As part of the Section on Medical Sciences, Pestell was elected for his distinguished contributions to cancer care as director of two National Cancer Institute cancer centers, including the KCC and Lombardi Cancer Center at the Georgetown University Medical Center, and for his research identifying new molecular targets and lightactivated gene therapy. Election as an AAAS Fellow is an honor bestowed upon AAAS members by their peers.
Whellan Named Assistant Dean for Clinical Research
David J. Whellan, MD, has been appointed to the new position of assistant dean for clinical research at Jefferson. Whellan, the James C. Wilson Associate Professor of Medicine and director of the Jefferson Coordinating Center for Clinical Research, will promote clinical research, support faculty’s research efforts in their respective clinical fields and integrate clinical research into overall strategy for Jefferson. He also will work to increase the translation of basic science discoveries into clinical studies.
Tanaka Awarded ‘Refunds for Research’ Grant
Takemi Tanaka, PhD, of the Jefferson School of Pharmacy and the Kimmel Cancer Center, received a $50,000 grant toward her breast cancer research as part of the Pennsylvania Breast Cancer Coalition’s “Refunds for Breast and Cervical Cancer Research” initiative. Tanaka’s research focuses on breast cancer metastasis.
Rincon Appointed to Medical Societies
Fred Rincon, MD, assistant professor of neurology and neurological surgery, was
Farber Institute Celebrates 10th Anniversary On April 18, 2012, Jefferson celebrated the 10th anniversary of the Farber Institute for Neurosciences by recognizing Vickie and Jack Farber during a daylong event. Committed to advancing neuroscience research and education, the Farbers generously provided the foundation for the Institute — whose faculty are dedicated to translating advances in basic research into clinical solutions for the millions of people suffering from neurological disorders — in 2002. The celebration included the presentation of a portrait of Vickie Farber by artist Dean Paules, which will hang in the Institute alongside a portrait of Jack. An evening reception featured guest speaker Jonathan Eig, author of Luckiest Man: The Life and Death of Lou Gehrig, highlighting the story of the baseball legend’s struggle with amyotrophic lateral sclerosis (Lou Gehrig’s disease).
SUMMER 2012 19
Surgery within 24 Hours Improves Cervical Spine Injury Outcomes
recently appointed to numerous medical societies. These appointments include being elected as member-at-large of the neurosciences section of the Society for Critical Care Medicine; being named chair of ethics section of Neurocritical Care Society; and being named a Fellow of the American Heart Association.
Weinstein Appointed Associate Editor for Podcast Series
Michael S. Weinstein, MD, associate professor of surgery and director of the Surgical Intensive Care Unit at Jefferson, has been named an associate editor and podcast host of the iCritical Care Podcasts (www.sccm.org/iCriticalCare). These podcasts feature interviews with authors from Critical Care Medicine and Pediatric Critical Care Medicine and other prominent members of the critical care community. Weinstein will assist in developing content and conducting interviews on medical topics within adult critical care.
Gonnella Receives International Honors
Joseph S. Gonnella, MD, director of the Center for Research in Medical Education and Health Care and emeritus dean of JMC, has been named honorary president of the Tokyo Bay Urayasu Ichikawa Medical Center in Tokyo, Japan, and has received an honorary degree in medicine from International Medical University in Kuala Lumpur, Malaysia.
KCC recently unveiled the region’s only image-guided brachytherapy suite, where patients can receive radiation imaging, planning and treatment in a single location. A dedicated room for high-dose brachytherapy helps medical physicists and radiation oncologists image and map out a course of treatment in real time and then administer the radiation from an adjacent “control room.” The suite is being used in treatment of prostate cancer as well as others, including gynecological and breast.
Researchers at the Rothman Institute at Jefferson have shown that patients who receive surgery less than 24 hours after a traumatic cervical spine injury suffer less neural tissue destruction and improved clinical outcomes. The multicenter study recruited 313 patients, 182 of whom underwent surgery less than 24 hours after an injury and 131 of whom underwent surgery at or after 24 hours. All were followed for six months post-surgery, and first group experienced significant improvement in neurologic 2.8 times more than the second. The results appeared online in PLoS ONE.
Brachytherapy Reduces Prostate Cancer Death Rates
Stronger Intestinal Barrier May Prevent Cancer
Spaeth Recognized at Home and Overseas
George L. Spaeth, MD, professor in the Department of Ophthalmology, was recently honored by both JMC and the Albert Schweitzer Foundation for his leadership in medical education. He is also an invited guest presenting at meetings around the world throughout 2012, including in New York, California, North Carolina, Germany, Denmark, France, Greece and Argentina.
Led by Xinglei Shen, MD, a resident in the Department of Radiation Oncology, researchers at the Kimmel Cancer Center at Jefferson have shown that brachytherapy can be an effective treatment option for high-risk prostate cancers. Brachytherapy involves the precise placement of radiation sources directly at the site of a tumor and is typically used to treat low- and intermediate-risk prostate cancers. A population-based analysis looking at almost 13,000 cases revealed that men who received brachytherapy alone or in combination with external beam radiation therapy had significantly reduced mortality rates. The findings were reported online in the International Journal of Radiation Oncology*Biology*Physics. Timothy Showalter, MD, assistant professor in the Department of Radiation Oncology, served as co-author.
The hormone receptor guanylyl cyclase C (GC-C) — a previously identified tumor suppressor that exists in the intestinal tract — plays a key role in strengthening the body’s intestinal barrier, which helps separate the gut world from the rest of the body and possibly keeps cancer at bay, according to a preclinical study led by Scott Waldman, MD, PhD, chair of the Department of Pharmacology and Experimental Therapeutics at Jefferson and director of the Gastrointestinal Cancer Program at the Kimmel Cancer Center. Without the receptor, that barrier weakens. Waldman’s team discovered that silencing GC-C in mice compromised the intestinal barrier, allowing inflammation to occur and cancer-causing agents to seep into the body, damaging DNA and forming cancer outside the intestine.
20 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Conversely, stimulating GC-C in intestines in mice strengthened the intestinal barrier. The findings were published online PLoS ONE.
Meditation Helps Patients with Memory Loss
Jefferson researchers have shown that mantra-based meditation can have a positive impact on emotional responses to stress, fatigue and anxiety in adults with memory impairment and loss. Their findings were published in the Journal of Alternative and Complementary Medicine. The study placed 15 older adults with memory problems ranging from mild ageassociated memory impairment to mild impairment with a diagnosis of Alzheimer’s disease on a regimen of Kirtan Kriya, a mantra-based meditation, for 12 minutes a day for eight weeks. A control group was assigned to listen to classical music for the same duration. Participants who performed the mantrabased meditation reported some improvement in tension, fatigue, depression, anger and confusion, with observed significance in tension and fatigue over the control group.
New Model Improves Students’ Empathy
Mohammadreza Hojat, PhD, research professor in the Department of Psychiatry and Human Behavior, has followed up his landmark 2011 study linking physician empathy to positive clinical outcomes with a new study examining methods to
Medical Frontiers improve empathy as a way to further enhance patient care. Hojat’s team used the Jefferson Scale of Empathy with pharmacy and medical students at Midwestern University before and after a 40-minute workshop during which they observed a theatrical performance about the challenges of aging. Results showed that the workshop increased empathy significantly from pre-test to post-test in both groups of students — however, empathy scores were not sustained. The findings were published in the American Journal of Pharmaceutical Education.
Post-Surgery Walking Program Helps Pancreatic Cancer Patients
Participation in a home walking program can lead to a significant improvement in quality of life, fatigue levels and physical functioning of post-surgery pancreatic cancer patients, according to findings from a study by Jefferson researchers published in the Journal of the American College of Surgeons on April 1, 2012. Pancreatic cancer patients at Jefferson will now receive an exercise prescription as part of their treatment plan. Theresa Yeo, PhD, CRNP, principal investigator of the study, says these findings are significant because fatigue is the most commonly reported symptom in cancer patients — and now action can be taken to minimize that.
Lung Cancer Screening Program Introduced
Using results from a nationwide trial of smokers, Jefferson experts have developed a comprehensive Lung Cancer Screening Program to help diagnose and treat the disease in its earliest stages. Data from the trial showed 20 percent fewer lung cancer deaths among participants with low-dose spiral CT, or helical CT, compared to those who were screened with the traditional chest X-ray. Spiral CT uses X-rays to obtain a multiple-image scan of the chest compared to a standard chest X-ray, which produces a single image in which anatomic structures overlie one another.
Innovative Procedure Removes Salivary Stones
Jefferson is the only hospital in the Philadelphia region offering an innovative, minimally invasive procedure to spare the salivary gland when treating sialolithiasis, a condition in which stones form within a salivary gland. Sialolithiasis affects 12 out of every 1,000 adults in the United States. Stones form when the flow of saliva slows and material, such as calcium deposits, form and block the outflow of saliva, causing pain and swelling. Previously, surgery to remove the salivary gland was the only treatment, but with the new procedure, called sialendoscopy, the gland is saved. David Cognetti, MD, otolaryngologist is co-director for the Center of Head and Neck Surgery at Jefferson.
SUMMER 2012 21
Study Shows Plavix® Allergy Can Be Overcome
Jefferson researchers, led by Michael P. Savage, MD, director of the Cardiac Catheterization Laboratory, have found that a combination of steroids and antihistamines can alleviate allergic reactions to Plavix®. Allergies to Plavix, also known by its chemical name, clopidogrel, occur in about 6 percent of patients given the drug, vital for the prevention of life-threatening stent thrombosis after angioplasty and percutaneous coronary interventions. Until now, hypersensitivity required drug interruption, placing the patient at risk for restenosis or a major coronary event. The study followed 24 patients who developed allergies after getting stents placed to reopen clogged heart vessels. Jefferson physicians were able to keep 88 percent of them on the drug after a short course of steroids and antihistamines.
Rothman Researchers Examine PJI Diagnosis
Researchers at the Rothman Institute at Jefferson have discovered that measurement of C-reactive protein in the synovial fluid — the viscous liquid that lubricates the joints and feeds the cartilage — is extremely accurate in the diagnosis of periprosthetic joint infection, while measuring a patient’s serum white blood cell count and the percentage of neutrophils, the conventional method for diagnosis, plays a minimal role. Javad Parvizi, MD, professor of orthopaedics at JMC, is the director of research at the Rothman Institute.
KCC Establishes Center to Eliminate Cancer Disparities
The Kimmel Cancer Center at Jefferson has established the Center to Eliminate Cancer Disparities in response to the Philadelphia region’s disproportionately high number of residents suffering from cancers, many of which are preventable and treatable. Edith P. Mitchell, MD, a medical oncologist and clinical professor in the Department of Medical Oncology, serves as director. Despite the decline in cancer and mortality rates in the United States, disparities continue among certain populations. The Center will facilitate disparities-focused research, researcher and clinician education and increased patient access to supportive services such as palliative care, cancer screening and prevention and survivorship programs.
Carotid Artery Stenting Safe in the Elderly
A multicenter team of investigators led by Nicholas J. Ruggiero II, MD ’01, director of Structural Heart Disease and Non-Coronary Interventions at Jefferson, have found that carotid artery stenting (CAS) is safe and effective in patients age 70 and older. Their research showed that while the instance of adverse events such as stroke, heart attack and death increases with age in this highrisk population, in comparison to historical data, the risk remains extremely low, at 6 percent, even in those ages 85 and up. Previous studies of elderly patients showed only a 7 percent risk of stroke, heart attack or death following carotid stent placement.
Jefferson Opens Barrett’s Esophagus Treatment Center
Jefferson has opened the new Jefferson Barrett’s Esophagus Treatment Center, one of few dedicated Barrett’s centers in the country and the first multidisciplinary center solely dedicated to treating Barrett’s esophagus disease in Philadelphia. Left untreated, Barrett’s esophagus — a condition caused when digestive acid backs up from the stomach into the esophagus, causing damage and the growth of pre-cancerous cells — can lead to esophageal cancer, an aggressive and often fatal cancer. The Center is led by some of the area’s most experienced gastroenterologists, including Anthony Infantolino, MD, director of the Center; Daniel Quirk, MD, MPH; and David Kastenberg, MD. A multidisciplinary team collaborates with gastrointestinal pathologists, surgeons, oncologists and radiologists — all highly experienced in the testing, evaluating, and treating Barrett’s esophagus and other esophageal conditions. Patients will also have access to ongoing and future clinical trials.
Myrna Brind Center Introduces Pediatrics Program
The new Integrative Pediatrics Program at the Jefferson-Myrna Brind Center of Integrative Medicine provides conventional pediatric medicine combined with evidencebased complementary therapies for patients 21 and younger. Board-certified pediatrician Christina DiNicola, MD, serves as director of the program, which treats a range of medical conditions including ADD/ADHD, allergies, asthma, behavioral and developmental concerns, digestive disturbances,
22 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
cancer care support, emotional health, eating problems, chronic headache, sleep problems and weight management.
Jefferson Launches Pre-Medical/ Pre-Pharmacy Program
In fall 2012, Jefferson College of Graduate Studies will launch the Postbaccalaureate Pre-Professional Program (P4), which focuses on helping individuals fulfill the basic science requirements needed for entrance to medical and pharmacy schools. In addition, the program offers professional development activities, opportunities to volunteer within the healthcare community and MCAT and PCAT exam preparation. The program initially will launch a twoyear track and will introduce an accelerated one-year pre-medical track in summer 2013. A highlight of the program is a linkage agreement with Jefferson Medical College, which gives a select group of students from the program the opportunity to qualify for early-decision acceptance or a guaranteed interview with JMC.
Project Wins Service Award
The ARCHES Project (Access and Advocacy; Research, Evaluation and Outcomes Measurement; Community Partnerships and Outreach; Health Education, Screening and Prevention Programs; Education of Health Professions Students and Providers; Service Delivery Systems Innovation) at Jefferson was one of 10 programs recently named a Program of Excellence by the Hospital Charitable Service Awards, a national program sponsored by Jackson Healthcare.
The project received a $10,000 grant with this recognition. The ARCHES Project supports community health by taking Jefferson health professionals and students into the community to provide medical services, health education and resources to current and formerly homeless men, women and children; diabetes self-management education to residents of North Philadelphia; education on healthy eating and safe places to be active for Philadelphia youths; and health education and prevention to treat the neighborhood economic, social and physical factors that are determinants of health and disease.
Thomson Reuters Ranks Jefferson Health System High
The Jefferson Health System, which includes Thomas Jefferson University Hospitals, Main Line Health and Magee Rehabilitation Hospital, has been named one of five of the highest-performing health systems in the “large health systems” category of Thomson Reuter’s fourth annual study identifying the top U.S. health systems based on system-wide clinical performance. The study compiled data from more than 300 organizations and singled out hospital systems that achieved superior clinical outcomes based on a composite score of eight measures of quality, patient perception of care and efficiency.
Jefferson Physicians Named ‘Top Doctors’
Seventy-eight Jefferson physicians representing 34 specialties were named to the annual Philadelphia magazine “Top Doctors” list, published in May 2012. “Top Docs” are selected by their peers. This year’s “Top Docs” issue included a feature called “28 Amazing New Ways Philly Doctors Can Save Your Life,” which outlined some of the most significant recent medical breakthroughs in the world. Among the advances highlighted was a half-match bone marrow transplant program revolutionized at the Kimmel Cancer Center at Jefferson. To read more about the program, see the fall 2011 issue of the JMC Alumni Bulletin at http://www.jefferson.edu/jmc/alumni/ bulletin/fall2011/index.html.
Rothman Spine Surgeons Recognized among Nation’s Best
Surgeons at the Rothman Institute at Jefferson were recently voted by their peers as three of the top 28 spine surgeons in the country. Todd Albert, MD, president of the Rothman Institute and chair of the Department of Orthopaedic Surgery; Alexander Vaccaro, MD, PhD, professor of orthopaedics and Neurosurgery and vice chair of the Department of Orthopaedics; and Alan Hilibrand, MD, professor of orthopaedic surgery and neurosurgery and director of medical education, were selected as among the finest surgeons, educators, investigators and administrators in America. The Rothman Institute is the only institution to have three surgeons on the list. The complete list appears on the industry website Orthopedics This Week.
SUMMER 2012 23
Marianne Ritchie, MD ’80, Becomes JMC Alumni Association President
In The Tipping Point, Malcolm Gladwell says, “Sprinkled among every walk of life … are a handful of people with a truly extraordinary knack of making friends and acquaintances. They are Connectors.” Marianne Ritchie, MD ’80, assistant professor of gastroenterology and new JMC Alumni Association president, is a connector extraordinaire. “I believe in the personal touch, in reaching out and connecting with people,” she says. “I cherish the lifelong friendships from my years at Jefferson, and one of my goals as president is to encourage other alumni to renew their friendships from their med school days by participating in our events.” Ritchie entered JMC just as the presence of women in the medical profession began to grow. Her class of 240 students, the largest medical school class in the country at that time, was 21 percent women. She made connections even then, when she was the sophomore selected as the moderator to orient the incoming freshmen. “They all seemed so nervous, and I wanted them to relax, so I told them that they were here because ‘we loved them’ — that Jefferson would not let them fail,” she says. “I was teased about that for a long time, but the best part of the story is that I met my husband during that orientation.” Her husband, Stuart Gordon, MD ’81, is now the division head of the Joint Replacement Program at Cooper University Hospital. One of the best moments of her life was on June 6, 1980, at the Academy of Music in Philadelphia, during commencement exercises. “Hearing my name called out —
Dr. Marianne Ritchie — made all the work and effort worthwhile,” she says. After graduation, she entered the male-dominated field of gastroenterology and was the first woman GI fellow at Memorial Sloan-Kettering Cancer Center in New York. “I was lucky to have outstanding mentors,” says Ritchie. “At SloanKettering, I worked with Bob Kurtz, MD ‘68, who was a great role model for me, as was Sidney Winawer, MD, chief of gastroenterology. He was a man of great distinction and a world-renowned expert in colon cancer screening and early detection. And I’ll never forget the first day as a junior student on my medicine rotation at Lankenau when I met Franz Goldstein, MD ’53. We had a patient with Crohn’s disease, and Dr. Goldstein gave me a personal mini-seminar on the disease. He walked away with the tails of his starched coat flapping, and I thought, I want to be just like him. Little did I know that one day we would be partners.” In 1988, she and classmate Barbara Frieman, MD ’80, connected with women on campus to form a group that would one day become the annual Women’s Forum. “Working with the Women’s Forum prepared me for my new role as alumni association president,” she says. “It introduced me to women I might not have met otherwise, and I’m proud that the forum gives students an opportunity to form relationships with mentors.” This year marks the Women’s Forum’s 25th anniversary. After Sloan-Kettering, she became the first woman in gastroenterology on the Main Line
at Lankenau Hospital, where she practiced for 14 years. Later she taught at Temple University Hospital, but she came full circle by returning to Jefferson in 2008. “Jefferson GI is an extremely collegial division with a superstar chief in Jay DiMarino.” Ritchie has maintained her connection with Jefferson for more than 30 years, serving as reunion chair for her class. “The class of 1980 had great chemistry,” she says. “In fact, we liked each other so much, we had a one-year reunion, and 75 people came!” Since then, she has been active in the alumni association, and in 2011 created the first “Jeff at the Beach” event. “People like to share stories with each other, and what better place to do that than in a relaxed, fun setting at the shore? Events like this really demonstrate the camaraderie that Jefferson classes are famous for,” she says. Ritchie also encourages alumni to use the online social network set up for JMC last year. “It’s a great way to maintain connections that will lead to less Facebook and more face time.” Ritchie is already working on plans for an annual alumnae brunch starting this September, and she has other ideas to strengthen connections. “Earlier this year, I went to Israel with some of our alumni, and the trip was incredible because of my fellow travelers,” she says. “Maybe we can plan other alumni trips in the future. I hope Jeff alumni will contact me so together we can make the JMC Alumni Association the best it has ever been.” Ritchie can be reached via email at email@example.com. — Gail Luciani
DON’T MISS PEARLS AT WORK, a Sunday morning fashion show and brunch for JMC alumnae and female faculty at this year’s alumni weekend, September 21 – 23! For details, visit http://connect.jefferson.edu/PearlsAtWork.
24 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
SUMMER 2012 25
188th Jefferson Medical College Commencement On May 21, 2012, JMC recognized 252 newly minted MDs during commencement at the Kimmel Center for the Performing Arts. The celebration featured keynote speaker Barbara F. Atkinson, MD ’74, who received an honorary doctor of science degree before addressing the crowd. Atkinson, a pathologist, urged graduates to find their true passions and strive for leadership roles. Above all, she encouraged them to remain open-minded, explaining that she never would have predicted that administrative roles would bring her career’s greatest highlights. Atkinson is the former executive vice chancellor of the University of Kansas Medical Center and the executive dean of the University of Kansas School of Medicine. She was the first woman to hold both positions at a U.S. medical center. In 2010, President Barack Obama appointed her to the Presidential Commission for the Study of Bioethical Issues, an advisory panel comprising the nation’s top leaders in medicine, science, ethics, religion, law and engineering.
26 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Michael Ciminiello, MD ’02: Slugger to Surgeon To say Michael Ciminiello’s family shares a passion for baseball would be an understatement. Long Island, N.Y., natives and longtime Yankees fans, Ciminiello and his three brothers all played Division I college baseball; their sister played Division I softball. Ciminiello served as team captain his junior and senior years at Princeton and, upon graduation, was drafted by the Detroit Tigers and played in the organization’s minor league system for a year. But then, medicine called. “My interest in medicine actually goes as far back as my interest in baseball,” Ciminiello says. “My dad’s a dentist, but he didn’t push me into med school. However, my parents always held our family physicians in high esteem, and that rubbed off on me. You gravitate toward what you respect.” Ciminiello says he always knew medicine — not baseball — would shape his “real” career. He chose to leave the single-A
New York Penn League so he could complete the prerequisite courses needed for medical school and entered JMC in 1998. A year later, his brother, Angelo, followed. “I enjoyed Jefferson from the start, but having my little brother right behind me made the experience just that much more fun and exciting,” he says. Although both men practice orthopaedic surgery today, Michael initially pursued another specialty, cardiothoracic surgery. He matched for a residency at New YorkPresbyterian Hospital/Weill Cornell Medical Center but quickly felt unfulfilled in the position. After realizing cardiac surgery wasn’t the right fit, he returned to Jefferson for a residency at the Rothman Institute, where he stayed on for clinical fellowship. “I am still incredibly grateful for that opportunity to come back, so much that I almost stayed on as an attending and became a Jefferson ‘lifer,’” he says. “But the pull of my entire family back home on
Long Island was just too strong. Home for me is wherever my family is.” Ciminiello now performs all procedures related to adult hip and knee reconstruction, focusing primarily on replacement surgery at the Krauss Center for Joint Replacement at Peconic Bay Medical Center in Riverhead, N.Y. “Orthopaedics makes sense for obvious reasons, given my background in sports. But I also like doing procedures that are going to change people’s lives in a significant way for the long term. Joint replacement surgery allows me to help people in a way that I know is going to be reliable and produce results that patients can see and feel every day,” he says. Outside of work, Ciminiello spends most of his time with his wife, Noelle, and their four children. He remains an enthusiastic baseball fan and, thanks to his positive experiences in Philadelphia, often roots for the Phillies — “unless they are playing the Yankees.” — Karen L. Brooks
SUMMER 2012 27
â€œMy interest in medicine goes as far back at my interest in baseball. My parents always held our family physicians in high esteem, and that rubbed off on me. You gravitate toward what you respect.â€?
28 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Victor F. Greco received the 2012 UNICO National Marconi Science Award, which honors a U.S. citizen of Italian descent for accomplishments in the physical sciences. Greco, a retired general and thoracic surgeon, helped develop the heart-lung machine and was a member of the team that performed the first successful open heart surgery in 1953. He lives in Drums, Pa.
Walter D. Dalsimer has six great-grandchildren and lives in Westpoint, Ind. Robert Poole spent the winter of 2011–2012 speaking to a variety of groups about his book, My Uncle Sam Needs a House Call, which addresses the societal breakdown of the United States over the past 50 years, as seen through the eyes of a small-town family physician. Poole lives in Newtown Square, Pa. Robert J. Rubin is retired from his role as chief of surgery at JFK Hospital in Edison, N.J. He is an avid fisherman and says he misses the “old days” at Jefferson. Rubin lives in Watchung, N.J.
Hubert R. Nestor is retired from his practice of child and adult psychiatry. He lives in San Clemente, Calif.
Arthur DiNicola received the 2012 Minersville Lion’s Club Citizen of the Year Award. The club works to improve the quality of life for residents of Minersville and Schuylkill County, Pa., by providing support for health issues, youth programs, disaster relief and other community needs. John Flanagan and his wife, Nancy, recently celebrated their 80th birthdays and report that their “wheels haven’t fallen off
yet!” They live in West Chester, Pa. Flanagan hopes to see many friends during the 2012 JMC reunion weekend in September.
Gerald Labriola released his 12th book in April 2011. He has penned eight mysteries and four books dealing with forensic science. Labriola lectures on cruise ships speaking on forensic science and high profile crime cases. He lives in Naugatuk, Conn.
Joel S. Bayer and his wife, Karen, moved to Hilton Head, S.C., in 2006 and are enjoying the warm weather.
Allen S. Laub retired in July 2012 after 42 years in pediatric private practice. He lives in New City, N.Y.
Nathan Cohen retired in 2008 after 35 years with Kaiser Permanente. He worked at the San Rafael Medical Center, where Gordon Manashil, MD ’66, was chief physician until retiring in 2007. Cohen reports that at age 70, he feels lucky to be in good health and still engaged in psychiatry. He lives in Larkspur, Calif.
Scott C. Stein recently celebrated his 70th birthday with his family. He is director of anesthesia at Rand Eye Institute in Pompano Beach, Fla., and has no plans of retiring because he enjoys practicing medicine so much. Stein lives in Boynton Beach, Fla.
Alexander C. Gellman has spent the past six years teaching urology to a Khmer general surgeon, which he says has been a rewarding experience. Gellman practices in Pennville, N.J., and has four granddaughters. He puts a lot of miles on his Harley
Davidson and is an elected councilman in Rockaway, N.J., which he finds a fascinating change from medicine.
Christopher K. Balkany was pleased to see many of his JMC classmates at their 40th reunion in 2011. Balkany lives in St. Cloud, Minn., and practices endocrinology on a part-time basis. His daughter, Anne, starts at Jefferson in fall 2012. John F. Motley retired from practicing pediatrics and family medicine in 1997 after developing painful idiopathic polyneuropathy. By 2007, he was home in Lansdale, Pa., in bed under the care of his wife of 42 years, Kate. Motley now enjoys spending time with his six grandchildren, collecting models, listening to music and watching movies, the National Geographic channel and “CSI: Miami” on television. He publishes a newsletter for family and friends every two days.
John A. Ferris III retired from practicing rheumatology in summer 2011 and now teaches U.S. history at a private school. He lives in Holden, Mass.
Michael E. Goldberg is chair of anesthesiology and associate dean of academic affairs at Cooper Medical School of Rowan University in Camden, N.J. His son, Corey Goldberg, MD ’11, is an emergency medicine resident in Jacksonville, Fla.
Tina M. Smith is chief of plastic surgery at Kaiser Permanente in the Diablo, Calif., service area and performs a wide range of reconstructive plastic surgery procedures. She lives in San Francisco with her husband, Ynze Bijl, who works in media production, and children, Zoe and Teo. Zoe is
about to begin her senior year of high school and is a competitive gymnast, and Teo recently completed his first year at the School of the Art Institute of Chicago.
Theodore J. Daly and his wife, Helen, are in Masai Mara, Kenya, volunteering their dermatologic, pediatric and dermatopathology services for Free the Children. They send well wishes to all in the JMC Class of 1983.
Thomas J. Gavin has been named medical director at the new Emergency Care Center at the OhioHealth Westerville Medical Campus. Gavin has been with OhioHealth since 2007, working as an emergency physician at Grant Medical Center, Riverside Methodist Hospital and Dublin Methodist Hospital. He lives in Westerville, Ohio, with his wife, Karen, and their two sons.
Vikram S. Kashyap has been appointed professor and chief of vascular surgery at University Hospitals Case Medical Center in Cleveland. Kashyap is also an American College of Surgeons Traveling Fellow to Australia and New Zealand. He and his wife, Sangeeta Kashyap, MD, and their three children live in Moreland Hills, Ohio.
John M. Duch is an interventional nephrologist in Lincoln, Neb. He is married with two children.
Philip D. Kousoubris is busy in neuroradiology at Lahey Clinic, a teaching hospital of the Tufts University School of Medicine in Massachusetts. He says his wife, Susanne Freitag, MD ’94, is even busier as director of the oculoplastics division of the Massachusetts Eye and Ear
SUMMER 2012 29
Send us your personal and professional updates for the Bulletin’s Class Notes! Contact Toni Agnes at 215-955-7751 or firstname.lastname@example.org. Mail to: Toni Agnes The Jefferson Foundation 925 Chestnut St., Suite 110 Philadelphia, PA 19107
Infirmary, and their daughter Allison, 10, is feeling overscheduled, too! The family lives in Chestnut Hill, Mass. Daniel Perlin will be inducted as president of the Medical Society of the District of Columbia in October 2012 after serving as president-elect for the past year. He also is a member of the organization’s board at large. Perlin works as clinical director of the outpatient operating room at Medstar Health Washington Hospital Center.
Steven E. Canfield writes that JMC and the Department of Urology provided him with wonderful opportunities to develop his career. He is chief of urology and residency program director at the University of Texas Medical School in Houston and would like to thank everyone at Jefferson — especially Leonard Gomella, MD — for all of their support.
Michael E. Pollack and his wife, Norma J. Johnson, MD ’96, live in Doylestown, Pa., with their two daughters. They both practice in Flemington, N.J., at Hunterdon Medical Center and Orthopedic Institute and send their best wishes to the entire Jefferson community.
Rita M. Pechulis is a partner with Pulmonary Associates PC in the Lehigh Valley Health Network in Allentown, Pa. She lives in MacUngie, Pa.
Christopher P. Henderson is a spine surgeon with Scranton Orthopaedic Specialists. He lives in Clark Summit, Pa., with his wife, Gretchen, and their three children.
Corey Waxman-Wasserman is a resident pediatrician at New York Presbyterian Hospital-Weill Cornell Medical Center. She recently became a contributing health editor for Fox News and lives with her husband, Jason Wasserman, MD ’11, in New York City.
Mark Graham, MD, PGY ’81, is associate director of the internal medicine residency program at Jefferson. His latest project has involved creating the first National Committee for Quality Assurance-certified patientcentered medical home in South Philadelphia. Graham says he is “living large and well in South Philadelphia and trying to make a good thing better.” Vasiliki Saitas, MD, PGY ’93, is medical laboratory director at Meadowlands Hospital Medical Center in Secaucus, N.J., as well as at Sovereign Medical Group LLC and Bergen Gastroenterology. Her 10-year-old son, Stavros, loves to look at cells under the microscope with her. Richard P. Winne Jr., PGY ’92, lives in Mendham, N.J., with his wife, Gail, and three daughters. He is a pain management specialist at Morristown Medical Center.
Frank A. Chervenak, MD ’76, Elected to Institute of Medicine of the National Academies Frank A. Chervenak, MD ’76, the Given Foundation Professor and Chair of obstetrics and gynecology at Weill Cornell Medical College and obstetrician, gynecologist-in-chief and director of maternal-fetal medicine at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, has been elected to the Institute of Medicine of the National Academies — an honor considered one of the most prestigious in medicine. His election was announced at the IOM’s annual meeting in Arlington, Va., in October 2011, and he will be formally inducted at a ceremony in October 2012. The IOM recognizes individuals who have made major contributions to the advancement of the medical sciences, health care and public health. “Dr. Chervenak has made many substantial contributions to the field of obstetrics and gynecology — particularly in the areas of ethics in maternalfetal medicine and global health — that have undoubtedly improved the health of mothers and children alike,” says Antonio M. Gotto Jr., MD, the Stephen and Suzanne Weiss Dean of Weill Cornell Medical College. Chervenak has published more than 260 peer-reviewed papers and has co-authored or co-edited 28 textbooks on topics including ultrasound and ethics in obstetrics and gynecology and physician leadership. He serves as president of the International Society of the Fetus as a Patient; president of the World Association of Perinatal Medicine; vice president of the International Academy of Perinatal Medicine; and co-director of the Ian Donald Inter-University School of Medicine and Ultrasound. He also serves on the March of Dimes Bioethics Committee and Prematurity Research Advisory Committee.
30 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Warren C. Herrold, 91, died Jan. 27, 2012, on his farm in York Haven, Pa. Herrold was a U.S. Army and Navy veteran and a member of the Alpha Omega Alpha Medical Honor Society. He worked as a family practitioner in Mount Wolf, Pa., for 43 years before retiring in 1990. He and his brother, Lewis C. Herrold, MD, established the Northeastern Medical Center, from which they provided medical care for residents of rural York County. Herrold is survived by five children, eight grandchildren and one greatgrandson.
John W. Davis, 94, of Hickory, N.C., died March 16, 2012. Davis served in the U.S. Army and was discharged as captain in the U.S. Army Medical Corps in 1949. He practiced internal medicine before retiring in 1989. Davis is survived by his wife of 68 years, Lucy, four sons and two daughters.
Thomas J. McBride, 88, of Wallingford, Pa., died April 26, 2012. After serving as a U.S. Army physician during the Korean War, McBride opened a private practice in internal medicine and cardiology. He served as chief of medicine at the former Sacred Heart Hospital in
Chester, Pa., from 1959 to 1973. He is survived by his wife, Olga, four sons and one daughter.
Robert E. Karns, 86, of Beachwood, Ohio, died in December 2011. Karns spent 31 years as chief of radiology at Manchester Memorial Hospital in Manchester, Conn., where he also served as chief of staff in 1983. He eventually moved to Beachwood, a suburb of Cleveland, where he worked part time as a radiologist for six years before retiring. He later maintained ties to medicine by volunteering at the Cleveland Health Museum. At his 50th JMC reunion in 2000, Karns established the Robert E. Karns, MD, Research Fund for Radiology — an invaluable gift that has supported advances in radiology research at Jefferson. Karns is survived by a son, a daughter and three grandsons. His wife, Cleo, preceded him in death.
Thomas S. Lynch, of Barnegat, N.J., died Feb. 20, 2102. During his career, he practiced family medicine in Illinois and New Jersey. He was a pioneer in the field of emergency medicine in Illinois, Maryland, Louisiana and New Jersey. Lynch is survived by three daughters, two sons and two grandchildren.
Joseph D. Cionni, 82, of Cincinnati, died Feb. 2, 2012. Cionni immigrated to the United States from Italy in 1947. He spent the majority of his life in Cincinnati, where he worked as a pediatrician for 21 years. He is survived by his wife of 56 years, Peggy.
Richard N. Smith, 83, of Jenkintown, Pa., died March 12, 2012. Over the years, he worked with children and their families in numerous psychiatric venues throughout the Philadelphia region. One of his proudest accomplishments involved helping to create the city’s first psychiatric unit for children in 1991 at Albert Einstein Medical Center. Smith is survived by his wife, Doranne, two sons, a daughter, five grandchildren and his loyal golden retriever, Golda.
Charles K. Gorby, 83, of Havertown, Pa., died March 4, 2012. Gorby was a fellow of the Academy of Psychosomatic Illnesses and a member of the Legion of Honor of the Chapel of the Four Chaplains. He served as a lecturer in pharmacology at Fitzgerald Mercy Hospital Nursing School, Sacred Heart School of Nursing, Villanova
University, Philadelphia College of Pharmacy and Science, the University of Pennsylvania and Hahnemann Medical College and was an assistant professor of clinical medicine at Jefferson. He was a staff member at Lankenau and Fitzgerald Mercy Hospitals for more than 50 years, served as a delegate to the Pennsylvania Medical Society and was president of the Delaware County Medical Society in 1986. Gorby is survived by his wife, Louise, three children and seven grandchildren.
E. Stephen Emanuel, 75, of Broomall, Pa., died Jan. 26, 2012. Emanuel had a private obstetrics and gynecology practice for 33 years and delivered more than 3,000 babies. After his retirement, he was a political activist for healthcare reform measures and was frequently quoted in the media. He also became involved with the Red Cross, assisting at blood drives. He is survived by his wife, Beverly, three children and four granddaughters. Leon Mironoff, 82, of San Clemente, Calif., died Jan. 26, 2012. Mironoff practiced family medicine. He is survived by his wife, Joy, and two children, George and Linda.
James W. Stratton, Longtime TJU Board Member James W. Stratton, emeritus trustee of Thomas Jefferson University, died April 18, 2012, in Florida. Stratton served as chairman of the TJU board of trustees from 1990 to 1994. An emeritus trustee since 2005, Stratton was one of the longest-serving members of the current board, having joined in 1970 at age 34. He held various leadership positions on the board, including chair of the Development Committee, founder of the Global Advisory Board and member of the Investment Committee. In 2005, he established The Paul C. Brucker, MD, Scholarship, which supports students from Pennsylvania State University in the Penn State–Jefferson Medical College accelerated degree program. He was also a major donor to the Dorrance H. Hamilton Building and the Bodine Center for Cancer Treatment. For these contributions and for his dedicated service to the University, he was given Jefferson’s Award of Merit in 2006.
SUMMER 2012 31
Alan B. Levy, 73, of Golden, Colo., died Oct. 21, 2011. As a young man, Levy worked as an orderly at Warren State Psychiatric Hospital in Pennsylvania, where he developed a sense of compassion and curiosity about mental illness. The job inspired his life’s work in psychiatry. He is survived by his wife of 43 years, Mary Ann, and two sons.
Thomas M. Kain III, 68, of Bryn Mawr, Pa., died April 26, 2012. An orthopaedic surgeon at Mercy Fitzgerald Hospital in Darby Borough, Pa., and at Riddle Memorial Hospital near Media, Pa., Kain was the fourth generation of his family to graduate from Jefferson. He is survived by his wife, Mary; his mother, Ruth; sons Daniel and Patrick; and daughters Aileen, Kathleen and Anne.
Michael D. Stulpin, 59, of Newtown Square, Pa., died Feb. 7, 2012. His practice was part of the Crozer-Keystone Health System, and he was an assistant medical director with Devon Health Services. He was a member of the Sharon Hill Board of Health and the American Academy of Family Medicine. He also was a physician for the Southeast Delco and William Penn School districts. Stulpin was a dog lover and collected model trains. He is survived by his wife, Anne; daughters Alexandra, Katherine and Elizabeth; and son Gregory.
The Dean’s Column period of time, or whether you plant the seeds of success that only bloom later. You can expect continuous hurdles as you embrace this power, but with determination you can find ways to overcome these hurdles. Problem solving is our fate. It is what energizes each of us individually and collectively. As framed by David Deutsch in his recent book, The Beginning of Infinity, we are all together on a collective journey of endless problem solving, with no end per se — life and mankind are about continuous, never-ending progress, improvement, and knowledge generation. These messages presently ring close to home. We are assembled here under the stewardship of President Barchi, as his last Jefferson Medical College graduation unfolds. Dr. Barchi has been a most extraordinary leader. In the course of his eight-year presidency, he transformed Jefferson’s campus — physically, programmatically, operationally, financially. His agency in all of this has been inspiring, as he has approached seemingly endless challenges with the relentless persistence of a Fleisher. Like Lown, he has seen sumptuous fruits of his labors. Yet he is also poised to hand off the baton, knowing that he will not be here to witness and seal all that he has set in motion. This is the Michael Collins dimension of leadership. And so it is for all of us in leadership roles. We each add our pieces to our institutions’ edifices. We plant many seeds, but by design, inherent in the human condition, we do not necessarily see them all fully bloom. We are part of an unfolding saga, building blocks in the continuing story of individual institutions and humanity at-large — and there is beauty in this more modest perspective. Drawing on a quote attributed to Will Eisner, my plea to you is: Be the ones to
continued from page 3
find the “impossible solutions for insoluble problems.” Like Lown, start great things, even if you only can spare time to do it as a sideline; like Collins, be enablers, confident that even if the limelight eludes you, what you do is important, and that you will benefit in any case, as you are on an endless journey of self-creation that is powered by your giving of yourself; and, like Fleischer, no matter what hurdle is thrown in your face, even when your strong right hand falters and ingenuity demands that you reinvent your weaker left hand, keep pressing forward with a confidence that most hurdles can be overcome. As you now take the sacred Oath of Hippocrates, hear the profession’s ancient call to service, heed its admonitions and affirm your commitment to others, in the most professional and altruistic ways. And permit yourselves to look beyond yourselves, think big, enable even if you won’t get full credit, and know that your agency is almost limitless if you simply plough through the obstacles before you. We salute all those that brought you to this point in life — your parents and family who nurtured and supported your passion for service and inquiry. All of our dreams go with you. You enter a long tradition that dates from Hippocrates, to McClellan and Gross, through Gibbon and now to you. It is your turn to join, to continue and to enhance Jefferson’s legacy of service, and to perpetuate that desire to make a difference that brought you to Jefferson four years ago.
Mark L. Tykocinski, MD Anthony F. and Gertrude M. DePalma Dean Jefferson Medical College
The Spring 2012 issue of the JMC Alumni Bulletin contained incorrect information in the memoriam for George W. O’Brien, MD ’50. We regret the error. The correct memoriam is: George W. “Bill” O’Brien, of Sacramento, Calif., died Jan. 12, 2010. He served his residency in psychiatry at Langley Porter Psychiatric Institute and internship at San Joaquin General Hospital in French Camp, Calif. O’Brien graduated from Carnegie Tech as an engineer in June 1943 and assisted in the design of the P-51 Mustangs used during World War II.
32 JEFFERSON MEDICAL COLLEGE ALUMNI BULLETIN
Facing Capital Gains? Donate your property — or a portion of it — to Jefferson. Do you have property that is a burden to manage? Do you own property you don’t use anymore? Will you owe significant taxes if you sell your property? If so, the Jefferson Foundation can help. By donating real estate to Jefferson, you can achieve peace of mind, create a lasting legacy and receive financial benefits for yourself or someone else.
What’s in it for you?
Depending on the nature of your gift and your objectives, you could: • Avoid capital gains taxes on appreciated property. • Eliminate the burden of maintaining and paying for the property. • Provide yourself with an annual income. • Reduce your estate and income taxes. The Jefferson Foundation staff will gladly discuss the various giving options associated with gifts of property and real estate. For more information contact Jennifer Welsh at the Jefferson Foundation at 215-955-9446 or email@example.com.
SUMMER 2012 33
By Numbers Tick-borne Diseases
Summer means more time outdoors, from camping in the mountains to hiking with your dog in the woods. Itâ€™s also a time to be aware of insect bites and tick-borne diseases, which are becoming more common as land development spreads further into remote locations. While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September), when ticks are most active. Number of tick species: More
Number of hours a tick must be attached before the Lyme disease bacterium can be transmitted:
36 or more.
Number of tick life stages: Four.
Number of days for antibodies for Borrelia burgdorferi, which causes Lyme disease, to be detected (seroconversion):
May take weeks.
Number of weeks that antibiotics are prescribed for treating Lyme disease patients:
How long a tick life cycle can take after hatching:
Two to four. NYMPH
Up to three years.
Tick most responsible for Lyme disease is Ixodes tick; number of confirmed Lyme disease cases in 2010:
More than 22,500.
Figures from the Centers for Disease Control and Prevention (CDC).
States reporting tick-borne relapsing fever, associated with sleeping in rustic cabins and vacation homes:
15 (Arizona, California, Colorado, Idaho, Kansas,
Montana, Nevada, New Mexico, Ohio, Oklahoma, Oregon, Texas, Utah, Washington and Wyoming).
Non-Profit Org. US Postage PAID Permit #276 Philadelphia, PA
925 Chestnut Street, Suite 110 Philadelphia, PA 19107-4216 Change Service Requested
Printed on FSC (Forest Stewardship Council) certified paper, which supports the growth of responsible forest management worldwide through its international standards.
Take our readership survey and you could win a $100 gift card! Please take a few minutes to complete our short survey about the JMC alumni publication, the Bulletin. Participation is confidential, but if you choose to submit your name, mailing address and email address when completing the survey, you will be entered in a raffle to win a $100 gift card! The deadline for responding is Aug. 31, 2012; the winner will be announced in the fall 2012 issue of the Bulletin.
There are three ways to submit your responses. 1. Fill out the survey on the postcard inserted in this copy of the Bulletin and drop it in the mail. 2. Take the survey online by visiting http://connect.jefferson.edu/bulletinsurvey. 3. Have a mobile phone? Scan this Quick Response (QR) code to link to the Bulletin reader survey. New to QR codes? Here’s how to do it: • Download a QR code reader for your phone. (Visit your online app store for options.) • Open it and use your phone’s camera to scan the code. (Follow onscreen instructions if your phone doesn’t automatically scan the code.) • Take the survey!
dership sur vey d win a $ 100 gift card!
That’s it! We look forward to hearing what you have to say about the Bulletin. Take ou r you cou readership surv ld win a $100 gif ey and There are th Please take ree ways t t card! 1. Ta o submit survey ab a few minutes to ke the yo
com ou publicatio t the Jefferson Med plete our shor t n, ic tial, but if the Bulletin. Particip al College alumni you choose ation is co address an nf to d email ad submit your nam idene, survey, yo dr u will be en ess when complet mailing ing the gift card! The deadlin tered in a raffle to win a $100 2012; the e for resp on w issue of th inner will be announ ding is Aug. 31, e Bulletin ced in the . fall 2012
Please an swer the qu es
su ur http://conn rvey online by visi responses. ting ect.jef fers on.edu/bul letinsur ve 2. Have a y. mob Response ile phone? Scan th (QR) is Quick code to lin k reader su to the Bulletin rv codes? Her ey. New to QR e’s how to do it:
• Downloa da phone. (V QR code reader fo is r for options it your online app your store • Open it .) and use yo ur phone’s to scan th ca e inst ruct io code. (Follow onsc mera re ns automat ic if your phone do en es al n’t ly scan • Ta ke th e survey! the code.)
tions belo 3. Fill ou w. t the closed an survey on this card 5. Does t 1. How o d drop it he Bulletin ften do yo in the mai , tape it strength u read th l. ti en on e Bulletin? your conn to JMC? ever y issu If no, ple e ec- 8. as A e qu re go you intere estion. If y to next occasional most issu sted in hav es, please es issues check all t version of ing a digi Reminds never hat apply the Bulle tal me of my . tin emaile experience 2. Which In Encourag d to you: ad di at sections o tio JMC n to receiv es me to su f t he ing a prin pport the Bulletin d tion financ yes regularly? t version instituo you read ia lly Please ch no eck all tha Instead of Helps me Main feat t apply. feel more receiv ing ures a print ve in touch w graduating yes Faculty pr rsion ith my class of iles no Prov ides A lumni pr usef ul info of iles 9. rm D m at o y io yo pr n related Student pr u use any ofession to of iles/stud of the follo practice? ent life wing in y Other ____ Message fr If no, ple our ________ om the de ase go to n __ If an y ________ es, please ________ ext quest Findings/r __ ch ion. __ ____ eck all tha esearch ________ __ t apply. iPhone or ________ On campu ______ ot her smar s tp 6. hone What act iPad or si Class note ions have milar devi s/in mem you ta ken ce oriam of reading Facebook as a resul the Bulle page t ti n? 3. Which Practice sp Attended topics are ecif ic web an event you intere site Other ____ in the Bu Made a do sted in se lletin? Plea ________ na ei ng tio n to JMC se check a ________ C New initi on ll that app ________ tacted a cl atives on ly. assmate or 10. Do yo campus friend Submitted Campus fa u read any a class no cilities an publicat te sm io d n gr ar Discu on an ow th tpho Fun
Thomas Jefferson University's quarterly magazine for the medical college published continuously since 1922
Published on Jul 23, 2012
Thomas Jefferson University's quarterly magazine for the medical college published continuously since 1922